Circular stapler for side to end, side to side and end to side anastomosis

ABSTRACT

A circular stapler for side to end, side to side or end to side anastomosis includes an actuating head portion attached to an elongated tubular body with a handle on the opposed end of the body from the head. The head includes an anvil and associated stapling mechanism, wherein the anvil and the associated stapling mechanism are positioned perpendicular to a longitudinal axis of the head. The anvil is releasably attached to the head and may be attached to the head through an anvil applicator. The anvil may include an extendable stem.

This application claims the benefit of U.S. Provisional PatentApplication Ser. No. 60/077,393 filed Mar. 10, 1998 entitled “CircularStapler for Side to End, Side to Side and End to Side Anastomosis”

BACKGROUND OF THE INVENTION

1. Field of the Invention

I, Enrico Nicolo, have invented a surgical tool which relates toanastomotic staplers, more particularly, to a circular stapler for sideto end, side to side or end to end anastomosis.

2. Background Information

In the anastomosis of two segments of a resected bowel, a surgicalcircular end to end anastomosis stapler is often used. These surgicaltools are conventionally called “EEA staplers”, “EEA devices” or simply“EEA's”. These devices are used to attach one longitudinal, generallycut, end of a bowel segment to another longitudinal, generally cut, endof a bowel segment. I have discovered that it may be beneficial toattach the side of one bowel segment to the end or to the side ofanother bowel segment in a bowel resection, or the like. This procedurewould be very helpful, for example, in performing the second stage of atwo-stage Hartman operation. However, there are currently no surgicaltools to easily accomplish this type of attachment.

An object of my invention is to provide a surgical anastomosis staplerwhich allows for the side of the lower bowel segment to be attached tothe end or to the side of another bowel segment to be attached thereto.A further object of my invention is to provide a surgical circularanastomotic stapler which is easy to manufacture and does not differsignificantly in operation from existing surgical staplers.

SUMMARY OF THE INVENTION

The above objects are achieved by providing a surgical circular stapleraccording to my invention which allows for side to end, side to side orend to side anastomosis. The stapler of my invention includes anactuating head portion attached to an elongated tubular body with ahandle on the opposed end of the body from the head. The head includesan anvil and associated stapling mechanism, wherein the anvil and theassociated stapling mechanism are positioned generally perpendicular tothe longitudinal axis of the head.

The handle may include a rotary control for actuating the anvil of thestapler and a trigger for firing of the staples in the staplingmechanism. The handle may further include a conventional safety lockwhich acts to prevent firing of the staples until the anvil is in theappropriate position.

The end of the head may be rounded to minimize potential trauma to thebowel or other hollow viscus. The widest dimension of the head should begenerally equal to the diameter of the circular head of a conventionalEEA stapler, which is generally less than about 35 mm. The head furtherincludes right angle drives for both the stapling mechanism and foroperation of the anvil.

The present invention additionally includes an anvil applicator forreceipt and delivery of the anvil of a surgical stapler where the anvilis to be attached to the head of the stapler at the anastomosis site.The anvil applicator may include a receiving sleeve and a reciprocatingplunger within the sleeve. Another aspect of the present inventionprovides a modified anvil with an extended stem. The extended stem maybe a telescoping member. The extended stem allows the surgeon to attachthe anvil to the head of the stapler at a more convenient location forbetter access and control. Both the anvil applicator and the modifiedanvil are not limited for use with the stapler of the present invention,but may be used with conventional staplers.

These and other advantages of my invention will be clarified in thedescription of the preferred embodiments taken together with theattached drawings wherein like reference numerals represent likeelements throughout.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of one embodiment of a circular stapler forside to end or side to side anastomosis according to my invention;

FIG. 2 is a front view of a head portion of the stapler illustrated inFIG. 1;

FIG. 3 is a side view of an anvil applicator for use with the staplershown in FIG. 1; and

FIG. 4 is a side view of a modified anvil for use with the stapler shownin FIG. 1.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

A surgical circular stapler 10 for side to end or side to sideanastomosis according to my invention is illustrated in FIGS. 1 and 2.The stapler 10 of my invention is similar to existing end to endanastomotic staplers, commonly called “EEA staplers”. The stapler 10includes an actuating head portion 12 attached to an elongated hollow,tubular body 14 with a handle 16 on the opposed end of the body 14 fromthe head 12. The body 14 may include a bend, as shown in FIG. 1, tobetter conform to the shape of the patient's bowel. The handle 16includes a rotary control 18 for actuating an anvil 22 of the stapler 10in a conventional fashion, as will be described. The handle 16 alsoincludes a trigger 20 for firing of the staples in a generallyconventional manner, as will be described. The handle 16 may furtherinclude a conventional safety lock (not shown in detail) which acts toprevent firing of the staples until the anvil 22 is in the appropriateposition relative to the head 12.

The construction of the head 12 differs significantly from existing EEAstaplers. Unlike existing EEA staplers, the anvil 22 and an associatedstapling mechanism (shown generally at 34) are positioned perpendicularto the longitudinal axis 24 of the head 12, as shown in FIG. 1. Thisconstruction allows the stapler 10 to perform side to end and side toside anastomosis. The end 26 of the head 12 is rounded to minimizepotential trauma to the bowel. In constructing the head 12, it isimportant to minimize the widest dimension of the head 12 about thelongitudinal axis 24. This dimension, shown at 28 in FIG. 1, willgenerally be along the axis of the anvil 22. The widest dimension 28should be generally equal to the diameter of a circular head ofconventional EEA staplers, which is generally about 30-35 mm. The widestdimension 28 is, therefore, less than about 35 mm for a conventionalstapler 10 for application in the bowel. This dimension needs to beselected to allow the bowel, or other hollow viscus, to accept the head12 of the stapler 10 without damage. The stapler 10 may be made of anysize, as with conventional staplers, with the dimension 28 essentiallythe size of the stapler 10. Typical sizes would be 21, 25, 28 and 33 mm.

In addition to the dimensional considerations, the head 12 of myinvention will require right angle drives for both the staplingmechanism 34 and operation of the anvil 22. The staples used in the head12 are conventional staples positioned opposed from the anvil 22 in theconventional manner and are, therefore, not shown in detail.Additionally, the staples may further be fired together with an internalring-shaped knife for trimming of the excess bowel portions, asconventional in the art. The staples and trimming knife of the staplingmechanism 34 do not form an essential part of the inventive concept ofmy invention and are, therefore, not shown in detail. FIG. 1 doesschematically illustrate one type of right angle actuator for staplingmechanism 34 for firing of the staples (and for actuation of thetrimming knife, if present). The right angle actuator includes a rod 30extending along the inside of the tube 14 and movable along the tube bytrigger 20 through a conventional linkage (not shown). The rod 30includes a ramp 32 at the end thereof which will engage and actuate thestapling mechanism 34 which is shown schematically in FIG. 1. It will beapparent that many other right angle actuators are possible, with thepresent system being only a representative example.

The anvil 22 also requires a right angle drive. In operation, the anvil22 can move relative to the head 12 by actuation of control 18. An openposition of the anvil 22 relative to the head 12 is shown in phantom inFIG. 1. The operation of the anvil 22 is substantially the same asexisting EEA staplers, except for the inclusion of a right angle drive.A stem 36 of anvil 22 will threadingly engage a rotatable sleeve (notshown) which is rotated by controller 18 through a rotatable shaft (notshown) extending through the tubular body 14. A pair of bevel gears maybe provided within the head 12 between the rotatable sleeve and therotatable shaft to accomplish the right angle drive. Bevel gears arewell known for providing a right angle rotational drive. Other rightangle rotational drives may be utilized, such as a flexible rotaryshaft.

A circular stapler 10 for side to end and side to side anastomosisaccording to my invention operates as follows. The stapler 10 isinserted into the lower bowel segment to be attached. At the anastomosissite, the anvil 22 is advanced to the open position (shown in phantom inFIG. 1). The anastomosis sites of the two bowel segments to be attachedare positioned between the anvil 22 and the head 12, and the anvil 22 istightened by operation of the control 18 to clamp the relevant sectionsof the two bowel segments together. Known pull strings, and the like,may be used to assure the proper positioning of the bowel segments to beattached around stem 36. The trigger 20 is actuated to fire staples andthe trimming knife, if any.

The anastomosis is now complete and the stapler 10 may be removed withany trimmed portions and pull string, or the like, secured between theanvil 22 and the head 12. The above operation is identical to existingEEA staplers except that the present invention allows for the side ofthe lower bowel segment to be attached to the end or to the side of theother bowel segment to be attached. Existing EEA staplers do not providefor this type of attachment between bowel segments.

The present stapler 10 will be particularly advantageous for performingthe second stage of a two-stage Hartman operation. In the first stage ofa two-stage Hartman operation, the patient undergoes a temporarycolostomy with the upper portion of the colon extending to the dermis ofthe patient to which a colostomy bag is attached, with the lower portionof the colon being closed for subsequent reattachment in the secondstage. In the second stage, the present invention allows for easyreattachment by inserting the stapler 10 into the upper bowel segmentand attaching the side of the upper bowel segment to the (previouslyclosed) end of the lower bowel segment. In such an operation, it wouldbe advantageous to remove the anvil 22 from the stapler 10 and advancethe anvil 22 transanally through the lower bowel portion to theanastomosis site. The stem 36 of the anvil 22 can be removed from theassociated elements of the stapler 10 with a conventional bayonetfitting, as known in the art. In order to further assist the attachmentof the anvil 22 with the head 12 of the stapler 10 at the anastomosissite, the present invention contemplates the use of an anvil applicator40 to receive and advance the anvil 22, as shown in FIG. 3. The anvilapplicator 40 is simply constructed and is formed of an anvil receivingsleeve 42 with a reciprocating, movable plunger 44 therein upon whichthe anvil 22 is mounted. The anvil applicator 40 greatly simplifies theoperation where the anvil 22 is attached to the head 12 at theanastomosis site, such as in the second stage of a two-stage Hartmanoperation where the anvil applicator 40 with anvil 22 can be advancedtransanally to the anastomosis site. When in position, at theanastomosis site, the plunger 44 can be advanced to move the anvil 22and the stem 36 into engagement with the head 12 of the stapler 10. Theremoval of the anvil 22 from the head 12 is similar to the removableanvil provided in conventional staplers. As known in the art, when theanvil of a stapler is attached to the stapler at the anastomosis site,it is common for the stem of the anvil to be pushed through a bowelportion to be attached, such as the closed lower end of a bowel segmentin the second stage of a two-stage Hartman operation. In such aprocedure, there is no need for pull strings to secure the relevantportions of the bowel around the stem of the anvil, as will be evidentto those of ordinary skill in the art.

The anvil applicator 40 of the present invention is not limited for usewith anvils 22 of the stapler 10 of the present invention. The anvilapplicator 40 may also be used with conventional anvils where the anvilis to be attached to a conventional stapler at the anastomosis site. Theanvil applicator 40 greatly simplifies the attachment of any anvil tothe corresponding stapler.

FIG. 4 illustrates a modified anvil 22′ according to the presentinvention. In certain open procedures, the position of the bowel withinthe operating environment can make it difficult to attach the stem 36 ofthe anvil 22 to the head 12 in operations where the anvil 22 is attachedto the stapler 10 at the anastomosis site. In order to simplify thisproblem, a modified anvil 22 is provided with a telescoping extendablestem 36′. The extendable stem 36′ may be on the order of 12 inches andis intended to give more room for easier attachment of the anvil 22′ tothe stapler 10. Once the stem 36′ and the corresponding element of thehead 12 have been attached, the rotary controls of the stapler 10 can beused to properly advance the anvil 22′ towards the head 12 in aconventional fashion. The extension of the stem 36′ allows the surgeonto make this attachment in a more convenient and easily accessiblelocation. The modified anvil 22′ is not limited for use with the stapler10 of the present invention. It is also believed to solve problems withconventional end to end staplers. Specifically, the same problems arisewith end to end staplers in certain open surgical procedures. If theanvil 22′ is used exclusively with end to end staplers, the telescopingstem 36′ may be replaced with an extended, flexible stem member, sincein a conventional end to end anastomosis stapler, the extendable stem36′ can be allowed to run the entire length of the handle portionthereof. The flexibility in such a stem would accommodate the bendnormally found in the extended handle of an end to end anastomosisstapler. Additionally, the stems 36 and 36′ of anvils 22 and 22′,respectively, should also be made as small as possible in diameter tominimize the trauma when these elements are pushed through associatedtissue.

My invention is not intended to be limited to bowel operations, butcould be used for anastomosis of any hollow viscus. According to myinvention, the anvil 22 and the associated stapling mechanism 34 arepositioned perpendicular to the axis 24 of the head 12. It will beapparent that various modifications may be made to the present inventionwithout departing from the spirit and scope thereof. Therefore, thescope of the present invention is intended to be defined by the appendedclaims and equivalents thereto.

I claim:
 1. An anastomotic surgical stapler comprising: an actuatinghead portion, said head portion including: i) a detachable anvil with astem engagable with a remainder of said head portion, said anvilreceiving and closing the staples of a closed loop of staples, and ii)an associated stapling mechanism within said head portion for firingsaid closed loop of staples against said anvil when said anvil and stemare attached to said remainder of said head portion, wherein said anvil,said stem and said stapling mechanism are positioned perpendicular to alongitudinal axis of said head portion; an elongated tubular bodyattached to and extending from said head portion, wherein said anvil,said stem and said stapling mechanism arc perpendicular to alongitudinal axis of said tubular body at the position where saidtubular body is attached to said head portion; and a handle on anopposed end of said tubular body from said head portion, wherein saidstapler may selectively be used for both side to side and end to sideanastomosis.
 2. The stapler of claim 1 wherein said handle includes arotary control for actuating said anvil and a trigger for firing staplesin said stapling mechanism.
 3. The stapler of claim 1 wherein an end ofthe head portion is rounded to minimize potential trauma to the patient.4. The stapler of claim 3 wherein said head portion further includes arecess spaced from said rounded end, said recess receiving said anvil.5. The stapler of claim 1 wherein a widest dimension of said headportion about said longitudinal axis is less than 35 mm.
 6. The staplerof claim 1 further including an anvil applicator adapted to selectivelyreceive said anvil.
 7. The stapler of claim 6 wherein said anvilapplicator includes an anvil receiving sleeve and a reciprocatingmovable plunger mounted within said anvil receiving sleeve.
 8. Thestapler of claim 1 wherein said anvil includes a telescoping stem.
 9. Ananastomotic surgical stapler for selectively performing both side toside and side to end anastomosis, said stapler comprising: a rigid,tubular body, a handle at on end of said body, and an actuating headportion at an opposite end of said body, said head portion including i)a stapling mechanism for firing a closed loop of staples substantiallyradially of the head portion to attach the side of a first hollow viscussurrounding said stapling mechanism to a second hollow viscus, and ii) aseparate, detachable anvil having a stem on said anvil for coupling saidanvil to said stapling mechanism, wherein said anvil receives saidclosed loop of staples to attach a side or an end of the second hollowviscus surrounding said anvil to the side of the first hollow viscus.10. The stapler of claim 9 wherein in at least one position said stem ison the order of about 12″ long.
 11. The stapler of claim 9 wherein saidstem includes telescoping segments.
 12. The stapler of claim 11 whereinsaid anvil and said stapling mechanism are orientated perpendicular to alongitudinal axis of said head portion.
 13. The stapler of claim 9wherein said anvil and said stapling mechanism are orientatedperpendicular to a longitudinal axis of said head portion.